Complex Osteotomy Have No Long-term Benefits for Primary tongue Cancers
Mandibulotomy, or "mandibular swing" osteotomy, is routinely used, to access the deep tumors in the posterior oropharynx and oral cavity. However, a study suggests that complex osteotomy does not offer long-term benefits in midline mandibulotomies for primary tongue cancers and has higher early infections. The study findings were published in the journal Head & Neck on December 01, 2020.
Osteotomy designs are highly debated in bone stability and consequent complications. Major variations include a straight-line osteotomy, a notched osteotomy, and a stair-stepped osteotomy. Theoretically, notched or stair-stepped mandibulotomy provides better occlusal stability, as increased bone contact restricts vertical movement. However, this hypothesis is based on anatomical inference than clinical induction. Therefore, researchers of the Chang Gung University College of Medicine, Taiwan, conducted a study, to determine whether osteotomy designs affect the incidence of common postoperative and postradiotherapy complications in patients with primary tongue cancer receiving a mid-line mandibulotomy.
It was a retrospective review study of 218 patients who underwent midline mandibulotomy for primary tongue cancer wide excision and flap reconstruction at Chang Gung Memorial Hospital during 2014‐2019. Among 218 patients, 114 had straight osteotomy, 54 had notched osteotomy, and 50 had stair‐stepped osteotomy cases.
Key findings of the study were;
• Upon analysis, researchers have noted that the stair‐stepped osteotomy had less advanced tumor stages and notched osteotomy more common single‐plate fixations.
• They found that the stair-stepped osteotomy showed higher mandibular heights and more intact midline teeth than notched and straight ones.
• They also found that the straight osteotomy cases showed lower early infection rates.
• Further, they noted that the single‐plate fixation was related to more flap dehiscence and oro‐cutaneous fistulas.
The authors concluded, "Complex osteotomy designs (of notched or stair-stepped types) does not offer long‐term benefits in midline mandibulotomies for primary tongue cancers and has higher early infections. Single‐plate fixation increases postoperative complications.
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